Essays on health outcomes and physician practice variation within a public single hospital : the case of Malta

Abstract

This thesis is about the measurement of health care output and the relationship between health care outcomes, physician practice patterns and individual physician characteristics within a very specific and particular health care sector, the health care sector on the Islands of Malta. Chapter 2 focuses on the appropriateness of introducing a Diagnosis Related Group (DRG) casemix classification system on Maltese data. A number of tests are applied to gauge the ability of Grouper software to capture the heterogeneity between the obtained DRG groups and the degree of homogeneity gained in explaining resource use from the grouping of cases by DRG categories. This serves to provide a measure of health care ‘output’ whilst providing a tool to help describe and manage resource use. Chapter 3 of this thesis explores differences in the expected relationship between volume and competing risk outcomes and whether this relationship varies in view of different consultant job contract conditions. Finally, Chapter 4 of this thesis studies the behaviour of individual consultants working in the context of the specific incentives and work practices of the Maltese health care system. The role of the specific consultant job contract type is investigated to explain heterogeneity arising among treatment practice patterns over two specific periods related to the patients’ stay at the hospital: the first two days of hospital stay and their remaining stay.